Assignment Of Bail Bond Form
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UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF FLORIDA
UNITED STATES OF AMERICA
)
Plaintiff,
)
Case No.
)
vs
)
)
ASSIGNMENT OF BAIL BOND
)
Defendant.
)
______________________________/
)
I, ________________________________, Cash Bond Depositor in the above numbered
(Complete name as appeared on original bond)
and styled cause, do hereby assign, transfer and authorize my case bond refund in the amount of
__________________________________ plus accrued interest to be made payable to
_________________________________________ whose mailing address is
(Complete name of assignee)
______________________________________________________________________________
(Street Address, City, State, and Zip)
upon final disposition of the above numbered and styled cause.
The undersigned Cash Bond Depositor understands that once this document is signed, all rights,
claims, and interest of ownership are immediately transferred to the above assignee.
(The above assignee must complete an Internal Revenue Service Form W-9 or if the assignee is a
nonresident alien individual, the assignee must complete a Form W-8, either of which may be obtained
from the Clerk’s Office Financial Section or Internet. The completed W-8 or W-9 form should be
provided to the Financial Section, but not filed in the Court file. Upon final disposition of the above
numbered and styled cause, a Motion for Disbursement of Bond, along with a signed copy of this form
must be filed with the Court. A check will be mailed to the address indicated on the completed form,
unless directed in writing otherwise.)
_______________________________
(Signature of Cash Bond Depositor)
_______________________________
(Date)
The foregoing instrument was acknowledged before me this ____ day of ________,
_______, by _______________ (Complete name as appeared on original bond), who personally
appeared
before
me
and
who
is
personally
known
to
me
or
has
produced
_________________________________________________ as identification.
___________________________________
NOTARY PUBLIC, STATE OF FLORIDA
Print Name: ________________________
My Commission Expires: _____________
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